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Carpeggiani C, Landi P, Michelassi C, Andreassi MG, Sicari R, Picano E. Stress Echocardiography Positivity Predicts Cancer Death. J Am Heart Assoc 2017; 6:e007104. [PMID: 29233827 PMCID: PMC5779024 DOI: 10.1161/jaha.117.007104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stress echocardiography (SE) predicts cardiac death, but an increasing share of cardiac patients eventually die of cancer. The aim of the study was to assess whether SE positivity predicts cancer death. METHODS AND RESULTS In a retrospective analysis of prospectively acquired single-center, observational data, we evaluated 4673 consecutive patients who underwent SE from 1983 to 2009. All patients were cancer-free at index SE and were followed up for a median of 131 months (interquartile range 134). We separately analyzed predetermined end points: cardiovascular, cancer, and noncardiovascular, noncancer death, with and without competing risk. SE was positive in 1757 and negative in 2916 patients; 869 cardiovascular, 418 cancer, and 625 noncardiovascular, noncancer deaths were registered. The 25-year mortality was higher in SE-positive than in SE-negative patients, considering cardiovascular (40% versus 31%; P<0.001) and cancer mortality (26% versus 17%; P<0.01). SE positivity was a strong predictor of cancer (cause-specific hazard ratio 1.19; 95% confidence interval, 1.16-1.73; P=0.05) and cardiovascular mortality (1.18; 95% confidence interval, 1.03-1.35; P=0.02). Fine-Gray analysis to account for competing risk gave similar results. Cancer risk diverged after 15 years, whereas differences were already significant at 5 years for cardiovascular risk. CONCLUSIONS SE results predict cardiovascular and cancer mortality. SE may act as a proxy of the shared risk factor milieu for cancer or cardiovascular death.
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Affiliation(s)
| | | | | | | | - Rosa Sicari
- CNR Institute of Clinical Physiology, Pisa, Italy
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153
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Waddingham PH, Bhattacharyya S, Zalen JV, Lloyd G. Contractile reserve as a predictor of prognosis in patients with non-ischaemic systolic heart failure and dilated cardiomyopathy: a systematic review and meta-analysis. Echo Res Pract 2017; 5:1-9. [PMID: 29258998 PMCID: PMC5744622 DOI: 10.1530/erp-17-0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/28/2022] Open
Abstract
Objective Patients with non-ischaemic systolic heart failure (HF) and idiopathic dilated cardiomyopathy (DCM) are a heterogenous group with varied morbidity and mortality. Prognostication in this group is challenging. We performed a systematic review and meta-analysis to examine the significance of the presence of contractile reserve as assessed via stress imaging on mortality and hospitalisation. Methods A search for studies that non-invasively assessed contractile reserve in patients with DCM or non-ischaemic HF with reduced ejection fraction, stress imaging with follow-up data comparing outcomes. A range of imaging modalities and stressors were included. We examined primary endpoints of mortality and secondary endpoints of combined cardiovascular events including HF progression or hospitalisation. Our analysis compared endpoints in patients with contractile reserve and those without it. Results Nine prospective cohort studies were identified describing a total of 787 patients. These studies are methodologically but not statistically heterogenous (I2 = 31%). Using a random effect model, the presence of contractile reserve was associated with a significantly lower risk of mortality and cardiovascular events odds ratios of 0.20 (CI 0.11, 0.39) (P < 0.00001) and 0.13 (CI 0.04, 0.40) (P = 0.0004), respectively. Conclusion Regardless of stressor and imaging modality and despite the significant methodological heterogeneity within the current data (imaging techniques and parameters), patients with non-ischaemic cardiomyopathy and reduced EF who demonstrate contractile reserve have a lower mortality, and lower events/hospitalisations. The presence of contractile reserve therefore offers a potential positive prognostic indicator when managing these patients.
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Affiliation(s)
| | | | - Jet Van Zalen
- Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, UK
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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O'Driscoll JM, Gargallo-Fernandez P, Araco M, Perez-Lopez M, Sharma R. Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography. Int J Cardiovasc Imaging 2017; 33:1711-1721. [PMID: 28685313 PMCID: PMC5682847 DOI: 10.1007/s10554-017-1163-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/08/2017] [Indexed: 12/22/2022]
Abstract
A number of parameters recorded during dobutamine stress echocardiography (DSE) are associated with worse outcome. However, the relative importance of baseline mitral regurgitation (MR) is unknown. The aim of this study was to assess the prevalence and associated implications of functional MR with long-term mortality in a large cohort of patients referred for DSE. 6745 patients (mean age 64.9 ± 12.2 years) were studied. Demographic, baseline and peak DSE data were collected. All-cause mortality was retrospectively analyzed. DSE was successfully completed in all patients with no adverse outcomes. MR was present in 1019 (15.1%) patients. During a mean follow up of 5.1 ± 1.8 years, 1642 (24.3%) patients died and MR was significantly associated with increased all-cause mortality (p < 0.001). With Kaplan-Meier analysis, survival was significantly worse for patients with moderate and severe MR (p < 0.001). With multivariate Cox regression analysis, moderate and severe MR (HR 2.78; 95% CI 2.17-3.57 and HR 3.62; 95% CI 2.89-4.53, respectively) were independently associated with all-cause mortality. The addition of MR to C statistic models significantly improved discrimination. MR is associated with all-cause mortality and adds incremental prognostic information among patients referred for DSE. The presence of MR should be taken into account when evaluating the prognostic significance of DSE results.
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Affiliation(s)
- Jamie M O'Driscoll
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
- School of Human and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Paula Gargallo-Fernandez
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Marco Araco
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Manuel Perez-Lopez
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Rajan Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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Cortigiani L, Carpeggiani C, Sicari R, Michelassi C, Bovenzi F, Picano E. Simple six-item clinical score improves risk prediction capability of stress echocardiography. Heart 2017; 104:760-766. [DOI: 10.1136/heartjnl-2017-312122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE).MethodsStudy includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups.ResultsDuring a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001).ConclusionsSimple clinical variables may be able to optimise SE risk stratification.
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Quality control of regional wall motion analysis in stress Echo 2020. Int J Cardiol 2017; 249:479-485. [PMID: 28986062 DOI: 10.1016/j.ijcard.2017.09.172] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. METHODS One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). RESULTS Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p<0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt. CONCLUSIONS In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit.
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Gimelli A, Liga R, Pasanisi EM, Casagranda M, Marzullo P. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J Nucl Cardiol 2017; 24:1542-1550. [PMID: 27025845 DOI: 10.1007/s12350-016-0456-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The interactions between non-obstructive coronary atherosclerosis (<50% stenosis) and myocardial perfusion and functional parameters on myocardial perfusion imaging (MPI) have never been evaluated. METHODS AND RESULTS One-hundred and ninety-five patients were submitted to stress-rest MPI and invasive coronary angiography. The presence of obstructive coronary lesions (>50% stenosis) was excluded. The summed stress score (SSS) was calculated in every patient. Moreover, the left ventricular (LV) ejection fraction (EF) and peak filling rate (PFR) were computed from gated MPI images as measures of systolic and diastolic functions. Sixty/195 patients (31%) showed the presence of non-obstructive atherosclerosis (>20% and <50% diameter reduction). Interestingly, they presented a higher SSS than those with normal coronary arteries (P < 0.001) despite a similar myocardial scar burden. If compared to patients with normal coronary arteries, those with non-obstructive atherosclerosis showed more abnormal post-stress PFR values (2.5 ± 0.9 vs 2.9 ± 0.8, P = 0.004), despite a similar EF. On multivariate analysis, the presence non-obstructive atherosclerosis was the only significant predictor (P = 0.026) of post-stress LV diastolic impairment, independently from perfusion parameters. CONCLUSIONS In patients without anatomically significant coronary lesions, the development of post-stress LV diastolic dysfunction on MPI associates with the presence of non-obstructive atherosclerosis on coronary angiography.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | | | - Mirta Casagranda
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Institute of Clinical Physiology, CNR, Pisa, Italy
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Ogoh S, Moralez G, Washio T, Sarma S, Hieda M, Romero SA, Cramer MN, Shibasaki M, Crandall CG. Effect of increases in cardiac contractility on cerebral blood flow in humans. Am J Physiol Heart Circ Physiol 2017; 313:H1155-H1161. [PMID: 28916637 DOI: 10.1152/ajpheart.00287.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 01/17/2023]
Abstract
The effect of acute increases in cardiac contractility on cerebral blood flow (CBF) remains unknown. We hypothesized that the external carotid artery (ECA) downstream vasculature modifies the direct influence of acute increases in heart rate and cardiac function on CBF regulation. Twelve healthy subjects received two infusions of dobutamine [first a low dose (5 μg·kg-1·min-1) and then a high dose (15 μg·kg-1·min-1)] for 12 min each. Cardiac output, blood flow through the internal carotid artery (ICA) and ECA, and echocardiographic measurements were performed during dobutamine infusions. Despite increases in cardiac contractility, cardiac output, and arterial pressure with dobutamine, ICA blood flow and conductance slightly decreased from resting baseline during both low- and high-dose infusions. In contrast, ECA blood flow and conductance increased appreciably during both low- and high-dose infusions. Greater ECA vascular conductance and corresponding increases in blood flow may protect overperfusion of intracranial cerebral arteries during enhanced cardiac contractility and associated increases in cardiac output and perfusion pressure. Importantly, these findings suggest that the acute increase of blood perfusion attributable to dobutamine administration does not cause cerebral overperfusion or an associated risk of cerebral vascular damage.NEW & NOTEWORTHY A dobutamine-induced increase in cardiac contractility did not increase internal carotid artery blood flow despite an increase in cardiac output and arterial blood pressure. In contrast, external carotid artery blood flow and conductance increased. This external cerebral blood flow response may assist with protecting from overperfusion of intracranial blood flow.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan;
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe-shi, Saitama, Japan
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Manabu Shibasaki
- Department of Environmental Health, Nara Women's University, Nara-shi, Nara, Japan
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; and
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Anchisi C, Marti G, Bellacosa I, Mary D, Vacca G, Marino P, Grossini E. Coronary flow reserve/diastolic function relationship in angina-suffering patients with normal coronary angiography. J Cardiovasc Med (Hagerstown) 2017; 18:325-331. [PMID: 26657083 DOI: 10.2459/jcm.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS Coronary blood flow and diastolic function are well known to interfere with each other through mechanical and metabolic mechanisms. We aimed to assess the relationship between coronary flow reserve (CFR) and diastolic dysfunction in patients suffering from angina but with normal coronary angiography. METHODS In 16 patients with chest pain and angiographically normal coronary arteries, CFR was measured using transthoracic echo-Doppler by inducing hyperemia through dipyridamole infusion. Diastolic function (E/A, deceleration time, isovolumetric relaxation time [IVRT], propagation velocity [Vp]) and left ventricular mass were evaluated by means of two-dimensional transthoracic echocardiography. RESULTS The patients were initially divided into two groups on the grounds of CFR only (ACFR: altered CFR, n = 9; NACFR: unaltered CFR, n = 7). Thereafter they were divided into four groups on the grounds of CFR and diastolic function (NN: normal; AA: altered CFR/diastole; AN: altered CFR/normal diastole; NA: normal CFR/altered diastole). Most of the subjects were scheduled in AA (n = 8) or NA (n = 5) groups, which were taken into consideration for further analysis. Patients were not different regarding various risk factors. ACFR and AA patients were older with normal body weight in comparison with NACFR and NA patients (P < 0.05). In the AA group, CFR and diastolic variables were found to be related to each other. CONCLUSION Diastolic dysfunction and reduced CFR were correlated in patients with concomitant alterations of those variables only. Because most risk factors were shared with patients with altered diastolic properties only, our findings could represent a direct relationship between altered CFR and diastole.
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Affiliation(s)
- Chiara Anchisi
- aCardiology Clinic bLaboratory of Physiology and Experimental Surgery, Department of Translational Medicine, Università del Piemonte Orientale 'A. Avogadro,' AOU 'Maggiore della Carità', Novara, Italy
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Velasco del Castillo S, Antón Ladislao A, Gómez Sánchez V, Onaindia Gandarias JJ, Cacicedo Fernández de Bobadilla Á, Rodríguez Sánchez I, Laraudogoitia Zaldumbide E. Influencia del riesgo cardiovascular en la predicción y el momento de aparición de eventos cardiacos tras ecocardiograma de esfuerzo sin isquemia. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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161
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Ciampi Q, Citro R, Severino S, Labanti G, Cortigiani L, Sicari R, Gaibazzi N, Galderisi M, Bossone E, Colonna P, Picano E. Stress echo in Italy. J Cardiovasc Med (Hagerstown) 2017. [DOI: 10.2459/jcm.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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162
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Hwang HJ, Sohn IS, Kim DH, Park CB, Cho JM, Kim CJ. Increased interarm blood pressure difference is associated with autonomic dysfunction and atherosclerosis in patients with chest pain and no history of coronary artery disease. Int J Cardiol 2017; 241:25-29. [DOI: 10.1016/j.ijcard.2017.03.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 11/26/2022]
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163
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Jansen F, Schäfer L, Wang H, Schmitz T, Flender A, Schueler R, Hammerstingl C, Nickenig G, Sinning JM, Werner N. Kinetics of Circulating MicroRNAs in Response to Cardiac Stress in Patients With Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.116.005270. [PMID: 28751542 PMCID: PMC5586407 DOI: 10.1161/jaha.116.005270] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Circulating microRNAs (miRNAs/miRs) are regulated in patients with coronary artery disease. The impact of transient coronary ischemia on circulating miRNA levels is unknown. We aimed to investigate circulating miRNA kinetics in response to cardiac stress in patients with or without significant coronary stenosis. Methods and Results Eighty of 105 screened patients with stable coronary artery disease underwent dobutamine stress echocardiography before coronary angiography. Nine circulating vascular miRNAs (miRNA‐21, miRNA‐26, miRNA‐27a, miRNA‐92a, miRNA‐126‐3p, miRNA‐133a, miRNA‐222, miRNA‐223, and miRNA‐199‐5p) were quantified in plasma by reverse transcription polymerase chain reaction before, immediately after, and 4 and 24 hours after dobutamine stress echocardiography. Quantitative polymerase chain reaction revealed increased miRNA‐21, miRNA‐126‐3p, and miRNA‐222 levels at 24 hours after dobutamine stress echocardiography in all patients. On coronary angiography, significant coronary artery stenoses (>80% diameter stenosis) were found in 41 patients. Stratifying patients according to the prevalence of significant stenoses, patients with stenosis showed an increase of circulating miRNA‐21, miRNA‐126‐3p, and miRNA‐222 in response to cardiac stress. In patients without significant stenoses (<50% diameter stenosis), miRNA‐92a levels gradually increased in response to cardiac stress. Conclusions miRNAs are distinctly released into the circulation in response to cardiac stress depending on the prevalence of significant coronary stenoses.
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Affiliation(s)
- Felix Jansen
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Lisa Schäfer
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Han Wang
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Theresa Schmitz
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Anna Flender
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Robert Schueler
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Christoph Hammerstingl
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Nikos Werner
- Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
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Gaibazzi N, Porter T, Lorenzoni V, Pontone G, De Santis D, De Rosa A, Guaricci AI. Effect of Coronary Revascularization on the Prognostic Value of Stress Myocardial Contrast Wall Motion and Perfusion Imaging. J Am Heart Assoc 2017; 6:JAHA.117.006202. [PMID: 28566297 PMCID: PMC5669203 DOI: 10.1161/jaha.117.006202] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The assessment of myocardial perfusion (MP) and wall motion (WM) using contrast dipyridamole echocardiography (cSE‐WMP) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events, but its long‐term value for fatal and nonfatal ischemic cardiac events, also with respect to patients undergoing revascularization or not, remains to be determined. Methods and Results One‐thousand three‐hundred and twenty‐nine patients with suspect or known CAD who underwent cSE‐WMP were followed for a median 5.5 years. The independent prognostic value of cSE‐WMP regarding cardiac death or nonfatal myocardial infarction was related to stress WM and MP, rest ejection fraction, clinical risk factors, and medications. Patients revascularized after cSE‐WMP were separately analyzed to determine whether the procedure influenced outcome and whether this depends on cSE‐WMP results. A total of 125 cardiac fatal and nonfatal ischemic events (9.4%) occurred during the follow‐up (61 deaths, 64 myocardial infarctions). The 5‐year event rate with normal MP and WM was 5.9%, 9.9% with isolated MP defects (normal WM), and 15.5% with both MP and WM abnormalities. In patients not undergoing revascularization (n=1111), reversible MP defects added discrimination value over WM response and clinical factors/medication data (P=0.001), while in the cohort undergoing revascularization (n=218), cSE‐WMP results did not influence outcome. Conclusions cSE‐WMP, with both contrast MP and WM assessments, provides independent, incremental prognostic information regarding ischemic cardiac events at 5 years in patients with known or suspected coronary artery disease. Revascularization reduces cardiac events after an abnormal cSE‐WMP, resulting in outcomes not different from those in patients with normal cSE‐WMP.
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165
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Wierzbowska-Drabik K, Miśkowiec D, Kasprzak JD. Systolic longitudinal strain correlates with visual assessment of regional left ventricular function during dobutamine stress echocardiography and discriminates the segments with induced contractility impairment. Echocardiography 2017; 34:1020-1028. [DOI: 10.1111/echo.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Dawid Miśkowiec
- Department of Cardiology; Medical University of Lodz; Lodz Poland
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166
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Roushdy A, Abou El Seoud Y, Abd Elrahman M, Wadeaa B, Eletriby A, Abd El Salam Z. The additional utility of two-dimensional strain in detection of coronary artery disease presence and localization in patients undergoing dobutamine stress echocardiogram. Echocardiography 2017; 34:1010-1019. [PMID: 28548371 DOI: 10.1111/echo.13569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Dobutamine stress echocardiogram (DSE) is a feasible and safe exercise-independent stress modality for diagnoses of coronary artery disease (CAD), but it is subjective, and operator dependant. Two-dimensional strain at peak stress could overcome these limitations and thus increase the accuracy of DSE. METHODS AND RESULTS This was a prospective observational study in which 80 patients underwent DSE, two-dimensional strain at peak stress, and coronary angiography. Global longitudinal strains (GLS) cutoff point of -16.75 had 77.42% sensitivity and 83.33% specificity to detect significant CAD. Global circumferential strain (GCS) cutoff point of -20.75 had 93.55% sensitivity and 66.67% specificity to detect significant CAD (P=.003, areas under the curve [AUC]=0.73). The average territorial strain cutoff point for significant left anterior descending (LAD) lesion was -15.4 with 77.78% sensitivity and 82.86% specificity (P=.0001, AUC=0.78) and for non-LAD lesion was -16.9 with 82.93% sensitivity and 53.85% specificity (P=.0009, AUC=0.69). Two-dimensional strain at peak stress showed better agreement than DSE as regard number of vessels affected (K=0.579 vs 0.107), LAD lesion detection (K=0.783 vs 0.438), and non-LAD lesion detection (K=0.699 vs 0.233). Global longitudinal strain (GLS) at peak stress reduced DSE false positivity by 83%; the number of false-positive patients was reduced from 18 patients to only three patients. CONCLUSION Two-dimensional strain at peak stress had an incremental value over DSE visual assessment/ wall-motion score index (WMSI) in reducing false-positive results of DSE. Two-dimensional strain at peak stress had greater accuracy than DSE alone not only in detection of significant CAD but also in detection of number of vessels with significant lesion as well as CAD localization.
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Affiliation(s)
- Alaa Roushdy
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | | | | | - Basem Wadeaa
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Adel Eletriby
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
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Scali MC, de Azevedo Bellagamba CC, Ciampi Q, Simova I, de Castro E Silva Pretto JL, Djordjevic-Dikic A, Dodi C, Cortigiani L, Zagatina A, Trambaiolo P, Torres MR, Citro R, Colonna P, Paterni M, Picano E. Stress echocardiography with smartphone: real-time remote reading for regional wall motion. Int J Cardiovasc Imaging 2017; 33:1731-1736. [PMID: 28550586 DOI: 10.1007/s10554-017-1167-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/13/2017] [Indexed: 01/06/2023]
Abstract
The diffusion of smart-phones offers access to the best remote expertise in stress echo (SE). To evaluate the reliability of SE based on smart-phone filming and reading. A set of 20 SE video-clips were read in random sequence with a multiple choice six-answer test by ten readers from five different countries (Italy, Brazil, Serbia, Bulgaria, Russia) of the "SE2020" study network. The gold standard to assess accuracy was a core-lab expert reader in agreement with angiographic verification (0 = wrong, 1 = right). The same set of 20 SE studies were read, in random order and >2 months apart, on desktop Workstation and via smartphones by ten remote readers. Image quality was graded from 1 = poor but readable, to 3 = excellent. Kappa (k) statistics was used to assess intra- and inter-observer agreement. The image quality was comparable in desktop workstation vs. smartphone (2.0 ± 0.5 vs. 2.4 ± 0.7, p = NS). The average reading time per case was similar for desktop versus smartphone (90 ± 39 vs. 82 ± 54 s, p = NS). The overall diagnostic accuracy of the ten readers was similar for desktop workstation vs. smartphone (84 vs. 91%, p = NS). Intra-observer agreement (desktop vs. smartphone) was good (k = 0.81 ± 0.14). Inter-observer agreement was good and similar via desktop or smartphone (k = 0.69 vs. k = 0.72, p = NS). The diagnostic accuracy and consistency of SE reading among certified readers was high and similar via desktop workstation or via smartphone.
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Affiliation(s)
- Maria Chiara Scali
- Cardiology Division, Nottola Hospital, Siena, Italy.,Cardiothoracic Department, Cisanello, Pisa, Italy
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Iana Simova
- Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
| | | | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Claudio Dodi
- Casa di Cura Figlie di San Camillo, Cremona, Italy
| | | | - Angela Zagatina
- Cardiology Department, Medika Cardiocenter, Saint Petersburg, Russian Federation
| | | | - Marco R Torres
- Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Paolo Colonna
- Heart Cardiology Hospital, Policlinico of Bari, Bari, Italy
| | - Marco Paterni
- Biomedicine Department, CNR, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56 124, Pisa, Italy
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56 124, Pisa, Italy.
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van Riel ACMJ, Opotowsky AR, Santos M, Rivero JM, Dhimitri A, Mulder BJM, Bouma BJ, Landzberg MJ, Waxman AB, Systrom DM, Shah AM. Accuracy of Echocardiography to Estimate Pulmonary Artery Pressures With Exercise: A Simultaneous Invasive-Noninvasive Comparison. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005711. [PMID: 28360262 DOI: 10.1161/circimaging.116.005711] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/06/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Exercise echocardiography is often applied as a noninvasive strategy to screen for abnormal pulmonary hemodynamic response, but it is technically challenging, and limited data exist regarding its accuracy to estimate pulmonary arterial pressure during exercise. METHODS AND RESULTS Among 65 patients with exertional intolerance undergoing upright invasive exercise testing, tricuspid regurgitation (TR) Doppler estimates and invasive measurement of pulmonary arterial pressure at rest and peak exercise were simultaneously obtained. TR Doppler envelopes were assessed for quality. Correlation, Bland-Altman, and receiver-operating characteristic curve analyses were performed to evaluate agreement and diagnostic accuracy. Mean age was 62±13 years, and 31% were male. High-quality (grade A) TR Doppler was present in 68% at rest and 34% at peak exercise. For grade A TR signals, echocardiographic measures of systolic pulmonary arterial pressure correlated reasonably well with invasive measurement at rest (r=0.72, P<0.001; bias, -2.9±8.0 mm Hg) and peak exercise (r=0.75, P<0.001; bias, -1.9±15.6 mm Hg). Lower quality TR signals (grade B and C) correlated poorly with invasive measurements overall. In patients with grade A TR signals, mean pulmonary arterial pressure-to-workload ratio at a threshold of 1.4 mm Hg/10 W was able to identify abnormal pulmonary hemodynamic response during exercise (>3.0 mm Hg/L per minute increase), with 91% sensitivity and 82% specificity (area under the curve, 0.90; 95% confidence interval, 0.77-1.0; P=0.001). CONCLUSIONS Agreement between echocardiographic and invasive measures of pulmonary pressures during upright exercise is good among the subset of patients with high-quality TR Doppler signal. While the limits of agreement are broad, our results suggest that in those patients, sensitivity is adequate to screen for abnormal pulmonary hemodynamic response during exercise.
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Affiliation(s)
- Annelieke C M J van Riel
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Alexander R Opotowsky
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Mário Santos
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Jose M Rivero
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Andy Dhimitri
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Barbara J M Mulder
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Berto J Bouma
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Michael J Landzberg
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Aaron B Waxman
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - David M Systrom
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.)
| | - Amil M Shah
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.C.M.J.v.R., B.J.M.M., B.J.B.); Netherlands Heart Institute, Utrecht (A.C.M.J.v.R., B.J.M.M.); Department of Cardiology, Boston Children's Hospital, and Harvard Medical School, MA (A.R.O., M.J.L.); Cardiovascular Medicine, Department of Medicine (A.R.O., J.M.R., A.D., M.J.L., A.M.S.) and Pulmonary and Critical Care Medicine, Department of Medicine, (A.B.W., D.M.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal (M.S.).
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Angina and Ischemia at 2 Years With Bioresorbable Vascular Scaffolds and Metallic Drug-eluting Stents. ESTROFA Ischemia BVS-mDES Study. ACTA ACUST UNITED AC 2017; 71:327-334. [PMID: 28461150 DOI: 10.1016/j.rec.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/16/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Bioresorbable vascular scaffolds (BVS) have the potential to restore vasomotion but the clinical implications are unknown. We sought to evaluate angina and ischemia in the long-term in patients treated with BVS and metallic drug-eluting stents (mDES). METHODS Multicenter study including patients with 24 ± 6 months of uneventful follow-up, in which stress echocardiography was performed and functional status was assessed by the Seattle Angina Questionnaire (SAQ). The primary endpoint was a positive result in stress echocardiography. RESULTS The study included 102 patients treated with BVS and 106 with mDES. There were no differences in the patients' baseline characteristics. Recurrent angina was found in 18 patients (17.6%) in the BVS group vs 25 (23.5%) in the mDES group (P = .37), but SAQ results were significantly better in the BVS group (angina frequency 96.0 ± 8.0 vs 89.2 ± 29.7; P = .02). Stress echocardiography was positive in 11/92 (11.9%) of BVS patients vs 9/96 (9.4%) of mDES patients in the (P = .71) and angina was induced in 2/102 (1.9%) vs 7/106 (6.6%) (P = .18), respectively, but exercise performance was better in the BVS group even in those with positive tests (exercise duration 9.0 ± 2.0minutes vs 7.7 ± 1.8minutes; P = .02). A propensity score matching analysis yielded similar results. CONCLUSIONS The primary endpoint was similar in both groups. In addition, recurrent angina was similar in patients with BVS and mDES. The better functional status, assessed by means of SAQ and exercise performance, detected in patients receiving BVS should be confirmed in further studies.
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170
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Gan LM, Svedlund S, Wittfeldt A, Eklund C, Gao S, Matejka G, Jeppsson A, Albertsson P, Omerovic E, Lerman A. Incremental Value of Transthoracic Doppler Echocardiography-Assessed Coronary Flow Reserve in Patients With Suspected Myocardial Ischemia Undergoing Myocardial Perfusion Scintigraphy. J Am Heart Assoc 2017; 6:JAHA.116.004875. [PMID: 28420647 PMCID: PMC5533003 DOI: 10.1161/jaha.116.004875] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Adenosine‐assisted transthoracic Doppler‐derived coronary flow reserve (TDE‐CFR) reflects coronary vascular function. The prognostic and incremental value of left anterior descending coronary artery TDE‐CFR above myocardial perfusion scintigraphy in patients with suspected myocardial ischemia has not yet been studied. Methods and Results Three hundred seventy‐one patients (mean age, 62.3±8.7 years; 46.8% males) referred to myocardial perfusion scintigraphy attributed to suspected myocardial ischemia were included in the study. The TDE‐CFR result was blinded to the referring physician. Patients were followed up regarding major cardiovascular events, defined as cardiovascular death, myocardial infarction, or acute revascularization during a median follow‐up time of 4.5 years. A TDE‐CFR value of ≤2.0 was considered reduced. Major cardiovascular events occurred during follow‐up in 60 patients (16.2%). A reduced TDE‐CFR was detected in 76 patients (20.5%). Patients with reduced TDE‐CFR had an event rate of 36.8% compared to 10.8% in patients with normal TDE‐CFR (unadjusted hazard ratio, 4.63; 95% CI, 2.78–7.69; P<0.001). In a multivariate model, TDE‐CFR remained a significant independent predictor of major cardiovascular events. The major cardiovascular events rate was 7.5% in patients without myocardial perfusion scintigraphy‐detected myocardial ischemia and normal TDE‐CFR (n=200), 24.2% in patients without ischemia but with reduced TDE‐CFR (n=33), and 46.5% in patients with both myocardial perfusion scintigraphy–detected myocardial ischemia and a reduced TDE‐CFR (n=43; P<0.001). Conclusions Coronary microvascular dysfunction, as determined by TDE‐CFR, is a strong independent predictor of cardiovascular events and adds incremental prognostic value compared with myocardial perfusion scintigraphy. The current study supports routine assessment of CFR in patients with suspected ischemic heart disease.
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Affiliation(s)
- Li-Ming Gan
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden .,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,AstraZeneca, Mölndal, Sweden
| | - Sara Svedlund
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ann Wittfeldt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Charlotte Eklund
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sinsia Gao
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Göran Matejka
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Amir Lerman
- Cardiovascular Division, Mayo Clinic, Rochester, MN
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171
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Velasco Del Castillo S, Antón Ladislao A, Gómez Sánchez V, Onaindia Gandarias JJ, Cacicedo Fernández de Bobadilla Á, Rodríguez Sánchez I, Laraudogoitia Zaldumbide E. Influence of Cardiovascular Risk in the Prediction and Timing of Cardiac Events After Exercise Echocardiogram Testing Without Ischemia. ACTA ACUST UNITED AC 2017; 70:736-743. [PMID: 28416165 DOI: 10.1016/j.rec.2016.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES There have been no analyses of the influence of cardiovascular risk as a predictor of events in patients with exercise echocardiography (EE) without ischemia. Our objective was to determine the predictors of cardiac events, paying special attention to cardiovascular risk. METHODS This study included 1640 patients with EE without ischemia. Of these, there were 1206 with no previously known coronary artery disease (CAD), whose risk of a fatal cardiovascular disease event was estimated according to the European SCORE (Systematic COronary Risk Evaluation) risk assessment system, and 434 with known CAD. The primary endpoint was cardiac event-free survival (EFS) (cardiac death, nonfatal acute coronary syndrome, and coronary revascularization). RESULTS After a median follow-up of 35 [23-54] months, no differences were found in cardiac EFS between patients with a SCORE ≥ 10 or diabetes and patients with previous CAD (89.8% vs 87.1%). In the first year, cardiac EFS was high in all groups (99.4% if SCORE < 5; 100% if 5-9; 98% if ≥ 10 or diabetes and 97% in patients with CAD). In the third year, cardiac EFS was similar in the group with SCORE ≥ 10 or diabetes (94.5%) and patients with CAD (91.1%, P = NS). In these patients, the annualized event rate was 2.8% and 2.55%, respectively, and was significantly higher than in groups with SCORE < 5 (0.6%) and SCORE 5-9 (0.12%). The most frequent events were non-ST-segment elevation acute coronary syndrome and late revascularization. Predictors of cardiac events were previous CAD, SCORE ≥ 10 or diabetes mellitus, creatinine clearance, left ventricular ejection fraction, and chest pain during EE. CONCLUSIONS Initial outcome after an EE without ischemia is favorable but is subsequently modulated by cardiovascular risk.
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172
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Abram S, Arruda-Olson AM, Scott CG, Pellikka PA, Nkomo VT, Oh JK, Milan A, Abidian MM, McCully RB. Frequency, Predictors, and Implications of Abnormal Blood Pressure Responses During Dobutamine Stress Echocardiography. Circ Cardiovasc Imaging 2017; 10:e005444. [PMID: 28351907 PMCID: PMC5408460 DOI: 10.1161/circimaging.116.005444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/15/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND It is not known whether abnormal blood pressure (BP) responses during dobutamine stress echocardiography (DSE) are associated with abnormal test results, nor if such results indicate obstructive coronary artery disease (CAD). We sought to define the frequency of abnormal BP responses during DSE and their impact on accuracy of test results. METHODS AND RESULTS We studied 21 949 patients who underwent DSE at Mayo Clinic, Rochester, MN, grouped by peak systolic BP achieved during the test. We also analyzed a subgroup who underwent coronary angiography within 30 days after positive DSE. The positive predictive value of DSE was calculated for each BP group. Patients with hypertensive response (n=1905; 9%) were more likely to have positive DSE than those with normal (n=19 770; 90%) or hypotensive (n=274; 1%) BP responses (32% versus 21% versus 23%, respectively; P<0.0001). Angiography, performed in 1126 patients, showed obstructive CAD (≥50% stenosis) in 814 patients and severe CAD (≥70% stenosis) in 708 patients. Positive predictive value of DSE was similar for patients who had hypertensive and normal BP responses (69% versus 73%; P=0.3), considering 50% stenosis cut point. The proportion of severe CAD (≥70% stenosis) was lower in patients who had hypertensive response compared with those who had normal BP response (54% versus 65%; P=0.005). CONCLUSIONS Patients with hypertensive response during DSE are more likely to have stress-induced myocardial ischemia compared with those with normal or hypotensive BP responses but are not more likely to have false-positive DSE results. They are, however, less likely to have higher grade or multivessel CAD.
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Affiliation(s)
- Sara Abram
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Adelaide M Arruda-Olson
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Christopher G Scott
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Patricia A Pellikka
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Vuyisile T Nkomo
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Jae K Oh
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Alberto Milan
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Mohamed M Abidian
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.)
| | - Robert B McCully
- From the Department of Cardiovascular Diseases (S.A., A.M.A.-O., P.A.P., V.T.N., J.K.O., M.M.A., R.B.M.) and Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN; and Department of Medical Sciences, University of Torino, Turin, Italy (S.A., A.M.).
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Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovasc Ultrasound 2017; 15:7. [PMID: 28327159 PMCID: PMC5361820 DOI: 10.1186/s12947-017-0099-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/15/2017] [Indexed: 12/18/2022] Open
Abstract
Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.
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Affiliation(s)
- Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy.
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174
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Sayyid ZN, Sellers ZM. Technological advances shed light on left ventricular cardiac disturbances in cystic fibrosis. J Cyst Fibros 2017; 16:454-464. [PMID: 28314540 DOI: 10.1016/j.jcf.2017.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 01/08/2023]
Abstract
Cystic fibrosis (CF), the most common autosomal recessive lethal disease in Caucasians, causes chronic pulmonary disease and can lead to cor pulmonale with right ventricular dysfunction. The presence of the cystic fibrosis transmembrane conductance regulator (CFTR) in cardiac myocardia has prompted debate regarding possible defective ion channel-induced cardiomyopathy. Clinical heart disease in CF is considered rare and is restricted to case reports. It has been unclear if this is due to the lack of physiological importance of CFTR in the heart, the relatively short lifespan of those with CF, or a technical inability to detect subclinical disease. Extensive echocardiographic investigations have yielded contradictory results, leading to the dogma that left ventricular defects in CF occur secondary to lung disease. In this review, we consider why studies examining heart function in CF have not provided clarity on this topic. We then focus on data from new echocardiographic and magnetic resonance imaging technology, which are providing greater insight into cardiac function in CF and demonstrating that, in addition to secondary effects from pulmonary disease, there may be an intrinsic primary defect in the CF heart. With advancing lifespans and activity levels, understanding the risk of cardiac disease is vital to minimizing morbidity in adults with CF.
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Affiliation(s)
- Zahra N Sayyid
- Stanford University, School of Medicine, Palo Alto, CA, United States
| | - Zachary M Sellers
- Stanford University, School of Medicine, Palo Alto, CA, United States.
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175
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Prognostic Value of Myocardial Perfusion Analysis in Patients with Coronary Artery Disease: A Meta-Analysis. J Am Soc Echocardiogr 2017; 30:270-281. [DOI: 10.1016/j.echo.2016.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 01/28/2023]
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176
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Le TT, Huang W, Bryant JA, Cook SA, Chin CWL. Stress cardiovascular magnetic resonance imaging: current and future perspectives. Expert Rev Cardiovasc Ther 2017; 15:181-189. [DOI: 10.1080/14779072.2017.1296356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thu-Thao Le
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Weiting Huang
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart Alexander Cook
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon-Loong Chin
- Department of cardiovascular medicine, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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177
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Kloosterman M, Damman K, Van Veldhuisen DJ, Rienstra M, Maass AH. The importance of myocardial contractile reserve in predicting response to cardiac resynchronization therapy. Eur J Heart Fail 2017; 19:862-869. [DOI: 10.1002/ejhf.768] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mariëlle Kloosterman
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Kevin Damman
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Dirk J. Van Veldhuisen
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Michiel Rienstra
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
| | - Alexander H. Maass
- Department of Cardiology; University of Groningen, University Medical Center Groningen; PO Box 30.001 9700 RB Groningen the Netherlands
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178
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Reant P, Dufour M, Peyrou J, Reynaud A, Rooryck C, Dijos M, Vincent C, Cornolle C, Roudaut R, Lafitte S. Upright treadmill vs. semi-supine bicycle exercise echocardiography to provoke obstruction in symptomatic hypertrophic cardiomyopathy: a pilot study. Eur Heart J Cardiovasc Imaging 2017; 19:31-38. [DOI: 10.1093/ehjci/jew313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
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179
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Scali MC, Cortigiani L, Simionuc A, Gregori D, Marzilli M, Picano E. Exercise-induced B-lines identify worse functional and prognostic stage in heart failure patients with depressed left ventricular ejection fraction. Eur J Heart Fail 2017; 19:1468-1478. [PMID: 28198075 DOI: 10.1002/ejhf.776] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 12/22/2022] Open
Abstract
AIMS Exercise stress echocardiography (ESE) is recommended by the European Society of Cardiology guidelines for the evaluation of heart failure (HF) patients. Recently, lung ultrasound (LUS) has been proposed for the assessment of extravascular lung water through B-lines. The aim of this study was to assess B-lines during ESE in HF. METHODS AND RESULTS Standard transthoracic and LUS evaluation was performed during semi-supine ESE in 103 NYHA class I-III HF patients (76 male; mean age 64 ± 12 years) with depressed left ventricular ejection fraction (35 ± 8%). B-lines were measured by scanning 28 intercostal spaces on antero-lateral chest, both at rest and at peak stress. Resting plasma B-type natriuretic peptide (BNP) levels and exercise capacity during cardiopulmonary testing with peak oxygen uptake (peak VO2 ) were assessed in all patients. All patients were followed up for a median of 8 months (first quartile, 6; third quartile, 11). LUS was feasible and interpretable in all subjects. The overall number of B-lines increased from rest (median 5, interquartile range 0-10) to peak stress (median 12, interquartile range 0-45) (P < 0.0001). The number of stress B-lines was closely correlated with resting log-BNP (r = 0.88, P < 0.0001) and peak VO2 (r = -0.90, P < 0.0001). During follow-up, 37 events occurred: 10 deaths, 23 re-hospitalizations for acute HF, and 4 non-fatal myocardial infarctions. Twelve-month event-free survival was 95% in the 36 patients with stress B-lines <30 (best cut-off identified by receiver operating characteristic curve analysis) vs. 7% in patients with ≥30 B-lines (P < 0.0001). CONCLUSION B-lines are easy to obtain, frequent in HF patients, and often increase during ESE. Adverse events were more frequent in patients with more B-lines during ESE.
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Affiliation(s)
- Maria Chiara Scali
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | | | - Anca Simionuc
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, Padova University, Padova, Italy
| | - Mario Marzilli
- Cardiothoracic Department, Pisa University, Pisa, Italy and Nottola Cardiology Division, Siena, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, Biomedicine Department, National Research Council, Pisa, Italy
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180
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Aleksandric S, Djordjevic-Dikic A, Beleslin B, Teofilovski-Parapid G, Stepanovic J, Banovic M, Ostojic M. Noninvasive measurement of coronary flow velocity reserve during inotropic stimulation as an additional tool for hemodynamic assessment of myocardial bridging. Int J Cardiol 2017; 229:64. [DOI: 10.1016/j.ijcard.2016.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
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181
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Rassi DDC, Vieira MLC, Furtado RG, Turco FDP, Melato LH, Hotta VT, Nunes CGDO, Rassi Jr. L, Rassi S. Dobutamine Stress Echocardiography Safety in Chagas Disease Patients. Arq Bras Cardiol 2017; 108:122-128. [PMID: 28099588 PMCID: PMC5344656 DOI: 10.5935/abc.20170002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/08/2016] [Accepted: 08/31/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. OBJECTIVES: To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. METHODS: Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. RESULTS: Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. CONCLUSION: DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found. FUNDAMENTO: Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas seguro, em pacientes coronarianos não chagásicos. Entretanto, há insegurança na prática clínica de indicá-lo no paciente chagásico, devido ao potencial arritmogênico já intrínseco nesta cardiopatia. OBJETIVOS: Analisar a segurança do EED em uma população de chagásicos com suspeita clínica de coronariopatia. MÉTODOS: Análise retrospectiva de um banco de dados de pacientes encaminhados para a realização do EED entre maio/2012 e fevereiro/2015. Avaliou-se pacientes consecutivos portadores de doença de Chagas e com suspeita de coronariopatia. Confirmou-se a sorologia para doença de Chagas em todos os pacientes. RESULTADOS: A média etária dos 205 pacientes analisados foi de 64 ± 10 anos, sendo a maioria do sexo feminino (65,4%). Nenhum paciente apresentou eventos adversos significativos, como infarto agudo do miocárdio, fibrilação ventricular, assistolia, acidente vascular encefálico, ruptura cardíaca ou morte. Quanto às arritmias, extrassístoles ventriculares frequentes ocorreram em 48% dos pacientes, taquicardia ventricular não sustentada em 7,3%, bigeminismo em 4,4%, taquicardia supraventricular e taquicardia ventricular sustentada em 1% e fibrilação atrial em 0,5%. CONCLUSÃO: O EED mostrou ser um exame seguro nessa população de pacientes chagásicos, onde nenhum desfecho grave foi encontrado.
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Affiliation(s)
- Daniela do Carmo Rassi
- Faculdade de Medicina da Universidade Federal de
Goiás (UFG) - Brazil
- Centro de Diagnóstico por Imagem (CDI),
Goiânia, GO - Brazil
- Hospital São Francisco de Assis; Goiânia,
GO - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (InCor) - Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração (InCor) - Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | - Luiz Rassi Jr.
- Centro de Diagnóstico por Imagem (CDI),
Goiânia, GO - Brazil
| | - Salvador Rassi
- Faculdade de Medicina da Universidade Federal de
Goiás (UFG) - Brazil
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182
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Wierzbowska-Drabik K, Plewka M, Kasprzak JD. Variability of longitudinal strain in left ventricular segments supplied by non-stenosed coronary artery: insights from speckle tracking analysis of dobutamine stress echocardiograms in patients with high coronary risk profile. Arch Med Sci 2017; 13:82-92. [PMID: 28144259 PMCID: PMC5206362 DOI: 10.5114/aoms.2016.60603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although global deformation parameters have been increasingly used for myocardial function analysis, there are sparse data concerning segmental deformation of the left ventricle (LV). Moreover, some studies suggest heterogeneity of strain among LV segments, which may be especially significant during stress echocardiography. We assessed quantitatively regional LV function in the setting of dobutamine stress echocardiography (DSE), to examine differences of longitudinal strain between basal, mid and apical LV segments and to compare variability of regional deformation between rest and the peak stage of DSE. MATERIAL AND METHODS Among 250 patients examined by DSE applied for diagnosis of ischemia, a subset of 111 patients without significant coronary stenoses in angiography was selected (68 females, mean age: 60 ±10 years). Systolic longitudinal strain (SLS) in individual LV segments at baseline and the peak stage of DSE was analyzed with speckle tracking echocardiography. RESULTS Inhomogeneity of SLS among the LV segments (p < 0.001) was observed at baseline and the peak stage. Dispersion indices were higher at the peak stage of DSE than at baseline (p < 0.001), and the lowest heterogeneity was observed among mid segments. The analysis of changes in SLS during DSE showed SLS reduction in basal and mid-ventricular segments and an increase in apical segments. CONCLUSIONS Significant heterogeneity of strain and the opposite direction of the longitudinal strain changes during DSE between apical and basal LV segments were observed. This variability among non-ischemic LV segments ought to be considered in quantification of LV function during DSE.
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Affiliation(s)
| | - Michał Plewka
- Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Jarosław D Kasprzak
- Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
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183
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Dual-Imaging Stress Echocardiography for Prognostic Assessment of High-Risk Asymptomatic Patients with Diabetes Mellitus. J Am Soc Echocardiogr 2017; 30:149-158. [DOI: 10.1016/j.echo.2016.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 12/16/2022]
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184
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Picano E, Ciampi Q, Citro R, D’Andrea A, Scali MC, Cortigiani L, Olivotto I, Mori F, Galderisi M, Costantino MF, Pratali L, Di Salvo G, Bossone E, Ferrara F, Gargani L, Rigo F, Gaibazzi N, Limongelli G, Pacileo G, Andreassi MG, Pinamonti B, Massa L, Torres MAR, Miglioranza MH, Daros CB, de Castro e Silva Pretto JL, Beleslin B, Djordjevic-Dikic A, Varga A, Palinkas A, Agoston G, Gregori D, Trambaiolo P, Severino S, Arystan A, Paterni M, Carpeggiani C, Colonna P. Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease. Cardiovasc Ultrasound 2017; 15:3. [PMID: 28100277 PMCID: PMC5242057 DOI: 10.1186/s12947-016-0092-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities. METHODS In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy). RESULTS We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios. CONCLUSIONS The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Antonello D’Andrea
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Maria Chiara Scali
- Cardiology Department, Pisa University and Nottola (Siena) Hospital, Pisa, Italy
| | | | | | - Fabio Mori
- Cardiology Department, Careggi Hospital, Florence, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Lorenza Pratali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Eduardo Bossone
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Fausto Rigo
- Division of Cardiology, Ospedale dell’Angelo Mestre-Venice, Mestre, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | | | - Giuseppe Pacileo
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Bruno Pinamonti
- Cardiology Department, University Hospital “Ospedale Riuniti”, Trieste, Italy
| | - Laura Massa
- Cardiology Department, University Hospital “Ospedale Riuniti”, Trieste, Italy
| | - Marco A. R. Torres
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Attila Palinkas
- Department of Internal Medicine, Elisabeth Hospital, Hodmezovasarhely, Hungary
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Dario Gregori
- Department of Biostatistics, University of Padua, Padua, Italy
| | | | | | - Ayana Arystan
- RSE, Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Marco Paterni
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Clara Carpeggiani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico of Bari, Bari, Italy
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Costantini CRF, Ramires JA, Costantini CO, Denk MA, Tarbine SG, Santos MDF, Zanuttini DA, Silveira CW, de Souza AM, de Macedo RM. Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve. Arq Bras Cardiol 2017; 108:38-46. [PMID: 27982159 PMCID: PMC5245846 DOI: 10.5935/abc.20160184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/08/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. OBJECTIVE To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. METHODS Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. RESULTS All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. CONCLUSION Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.
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Affiliation(s)
| | - Jose Antonio Ramires
- Instituto do Coração (InCor) - Faculdade de Medicina
da Universidade de São Paulo, São Paulo, SP - Brazil
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186
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Sicari R. Stress echocardiography: no more challenges! Eur Heart J Cardiovasc Imaging 2016:jew225. [DOI: 10.1093/ehjci/jew225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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187
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Papachristidis A, Roper D, Cassar Demarco D, Tsironis I, Papitsas M, Byrne J, Alfakih K, Monaghan MJ. The prognostic role of stress echocardiography in a contemporary population and the clinical significance of limited apical ischaemia. Echo Res Pract 2016; 3:105-113. [PMID: 27872150 PMCID: PMC5184777 DOI: 10.1530/erp-16-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION In this study, we aim to reassess the prognostic value of stress echocardiography (SE) in a contemporary population and to evaluate the clinical significance of limited apical ischaemia, which has not been previously studied. METHODS We included 880 patients who underwent SE. Follow-up data with regards to MACCE (cardiac death, myocardial infarction, any repeat revascularisation and cerebrovascular accident) were collected over 12 months after the SE. Mortality data were recorded over 27.02 ± 4.6 months (5.5-34.2 months). We sought to investigate the predictors of MACCE and all-cause mortality. RESULTS In a multivariable analysis, only the positive result of SE was predictive of MACCE (HR, 3.71; P = 0.012). The positive SE group was divided into 2 subgroups: (a) inducible ischaemia limited to the apical segments ('apical ischaemia') and (b) ischaemia in any other segments with or without apical involvement ('other positive'). The subgroup of patients with apical ischaemia had a significantly worse outcome compared to the patients with a negative SE (HR, 3.68; P = 0.041) but a similar outcome to the 'other positive' subgroup. However, when investigated with invasive coronary angiography, the prevalence of coronary artery disease (CAD) and their rate of revascularisation was considerably lower. Only age (HR, 1.07; P < 0.001) was correlated with all-cause mortality. CONCLUSION SE remains a strong predictor of patients' outcome in a contemporary population. A positive SE result was the only predictor of 12-month MACCE. The subgroup of patients with limited apical ischaemia have similar outcome to patients with ischaemia in other segments despite a lower prevalence of CAD and a lower revascularisation rate.
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Affiliation(s)
| | - Damian Roper
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniela Cassar Demarco
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ioannis Tsironis
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Papitsas
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Khaled Alfakih
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Lewisham Healthcare NHS Trust, London, United Kingdom
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
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188
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. The Sphinx's riddle: cardiovascular involvement in autoimmune rheumatic disease. BMC Cardiovasc Disord 2016; 16:204. [PMID: 27793103 PMCID: PMC5084462 DOI: 10.1186/s12872-016-0381-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/22/2016] [Indexed: 02/03/2023] Open
Abstract
Factors leading to Cardiovascular Disease (CVD) in Autoimmune Rheumatic Diseases (ARD) include: a) atherosclerosis and macro-microvascular coronary artery disease b) pericardial, myocardial and vascular inflammation c) heart valve disease d) heart failure and e) pulmonary hypertension. Cardiology utilizes various non-invasive imaging modalities, such as rest/stress Electrocardiogram (ECG), echocardiography, nuclear imaging and more recently Cardiovascular Magnetic Resonance (CMR) to detect ischemic or inflammatory disease in ARD. Exercise ECG is a reliable prognostic test for identification of patients either very unlikely or very likely to have cardiac events. However, this is not the case for intermediate risk patients. In stress echocardiography the diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. It provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion, but at a lower cost and without radiation exposure. Stress Myocardial Perfusion Scintigraphy (MPS) is a non-invasive imaging modality for patients with suspected coronary artery disease, but has important limitations including radiation exposure, imaging artefacts and low spatial resolution, which preclude detection of small myocardial scars commonly found in ARD. By identifying early stages of inflammation and perfusion defects, CMR can shed light on the exact pathophysiologic background of myocardial lesions, even if the underlying ARD seems stable. However, high cost and lack of availability and expertise limit wider adoption. Hopefully, CMR will not have the same fate as Oedipous, who despite answering the Sphinx’s riddle successfully, finally came to a bitter end; for in the case of CMR overcoming fate is, in fact, in our hands.
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Affiliation(s)
- Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, P. Faliro, Athens, Greece.
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, P. Faliro, Athens, Greece
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189
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Hoogslag GE, Joyce E, Bax JJ, Ajmone Marsan N, Delgado V. Assessment of global left ventricular excursion using three-dimensional dobutamine stress echocardiography to identify significant coronary artery disease. Echocardiography 2016; 33:1532-1538. [PMID: 27307310 DOI: 10.1111/echo.13285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quantitative three-dimensional (3D) dobutamine stress echocardiography (DSE) for myocardial ischemia detection may be an adjuvant to left ventricular (LV) wall-motion analysis. The aim of the current study was to assess the association between global 3D LV excursion during DSE and the presence of significant coronary artery disease (CAD) on coronary angiography. METHODS Three-dimensional DSE was performed in 40 patients (67±12 years, 68% male) who underwent subsequent coronary angiography (median 1.6 months later). Using 3D echocardiography, global LV excursion was measured (in a total of 680 segments) at rest and peak dose and the change between stages was calculated (peak-rest=∆global LV excursion). Significant CAD was defined as >70% stenosis on coronary angiography. RESULTS In total, 25 patients (63%) demonstrated significant CAD on coronary angiography. At rest, global LV excursion was similar in patients with and without significant CAD (5.1±0.2 vs 5.0±0.2 mm, P=.74). However, patients with significant CAD demonstrated a worsening in global LV excursion from rest to peak stress (from 5.1±0.2 to 4.1±0.2 mm, P<.001), while global LV excursion in patients without significant CAD remained unchanged (from 5.0±0.2 to 5.5±0.2 mm, P=.10). After adjusting for clinically relevant characteristics, ∆global LV excursion was independently associated with significant CAD (odds ratio 0.29, 95% confidence interval 0.12-0.72, P=.008). CONCLUSIONS Analysis of 3D echocardiographic LV excursion at global level on full-protocol DSE may be a helpful tool to detect CAD on coronary angiography.
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Affiliation(s)
- Georgette E Hoogslag
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Emer Joyce
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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190
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Ilardi F, Santoro C, Cirillo P, Esposito G, Trimarco B, Galderisi M. Quantitative detection of inducible ischemia during dobutamine stress by speckle tracking echocardiography: A dream comes true. Int J Cardiol 2016; 220:357-9. [PMID: 27393839 DOI: 10.1016/j.ijcard.2016.06.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
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191
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Bombicino SS, Iglesias DE, Mikusic IAR, D'Annunzio V, Gelpi RJ, Boveris A, Valdez LB. Diabetes impairs heart mitochondrial function without changes in resting cardiac performance. Int J Biochem Cell Biol 2016; 81:335-345. [PMID: 27682517 DOI: 10.1016/j.biocel.2016.09.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/15/2016] [Accepted: 09/24/2016] [Indexed: 01/20/2023]
Abstract
Diabetes is a chronic disease associated to a cardiac contractile dysfunction that is not attributable to underlying coronary artery disease or hypertension, and could be consequence of a progressive deterioration of mitochondrial function. We hypothesized that impaired mitochondrial function precedes Diabetic Cardiomyopathy. Thus, the aim of this work was to study the cardiac performance and heart mitochondrial function of diabetic rats, using an experimental model of type I Diabetes. Rats were sacrificed after 28days of Streptozotocin injection (STZ, 60mgkg-1, ip.). Heart O2 consumption was declined, mainly due to the impairment of mitochondrial O2 uptake. The mitochondrial dysfunction observed in diabetic animals included the reduction of state 3 respiration (22%), the decline of ADP/O ratio (∼15%) and the decrease of the respiratory complexes activities (22-26%). An enhancement in mitochondrial H2O2 (127%) and NO (23%) production rates and in tyrosine nitration (58%) were observed in heart of diabetic rats, with a decrease in Mn-SOD activity (∼50%). Moreover, a decrease in contractile response (38%), inotropic (37%) and lusitropic (58%) reserves were observed in diabetic rats only after a β-adrenergic stimulus. Therefore, in conditions of sustained hyperglycemia, heart mitochondrial O2 consumption and oxidative phosphorylation efficiency are decreased, and H2O2 and NO productions are increased, leading to a cardiac compromise against a work overload. This mitochondrial impairment was detected in the absence of heart hypertrophy and of resting cardiac performance changes, suggesting that mitochondrial dysfunction could precede the onset of diabetic cardiac failure, being H2O2, NO and ATP the molecules probably involved in mitochondrion-cytosol signalling.
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Affiliation(s)
- Silvina S Bombicino
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), School of Pharmacy and Biochemistry, Physical Chemistry Division, Buenos Aires, Argentina
| | - Darío E Iglesias
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), School of Pharmacy and Biochemistry, Physical Chemistry Division, Buenos Aires, Argentina
| | - Ivana A Rukavina Mikusic
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), School of Pharmacy and Biochemistry, Physical Chemistry Division, Buenos Aires, Argentina
| | - Verónica D'Annunzio
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), Faculty of Medicine, Buenos Aires, Argentina
| | - Ricardo J Gelpi
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), Faculty of Medicine, Buenos Aires, Argentina
| | - Alberto Boveris
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), School of Pharmacy and Biochemistry, Physical Chemistry Division, Buenos Aires, Argentina
| | - Laura B Valdez
- University of Buenos Aires, Institute of Biochemistry and Molecular Medicine (IBIMOL; UBA-CONICET), School of Pharmacy and Biochemistry, Physical Chemistry Division, Buenos Aires, Argentina.
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192
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Zagatina A, Zhuravskaya N, Egom E, Kovacova G, Kruzliak P. A novel method for left anterior coronary artery flow velocity assessment by transthoracic echocardiography at the peak of a supine bicycle test. Acta Radiol 2016; 57:1056-65. [PMID: 26676763 DOI: 10.1177/0284185115617350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of coronary flow is only performed during pharmacological tests. Supine bicycle tests permit the visualization of coronary flow assessments during exercise. PURPOSE To assess the parameters of coronary flow in the left anterior descending artery (LAD) during exercise, which could be a sign of significant LAD narrowing. MATERIAL AND METHODS A total of 253 patients were enrolled: Group 1, 186 non-selective participants before undergoing a coronary angiography; and Group 2, 67 controls without coronary artery disease (CAD). All the patients performed a supine bicycle echocardiography test. Coronary flow velocities and coronary flow velocity reserve (CFVR) were measured at the mid-segment of the LAD during exercise. Patients in Group 1 underwent a coronary angiography. RESULTS In comparison with participants without significant LAD stenosis, patients with LAD lesions had a lower ΔV (16 ± 21 vs. 27 ± 20 cm/s, P < 0.04) and a lower CFVR (1.5 ± 0.8 vs. 2.0 ± 0.6, P < 0.004). In comparison with patients without significant proximal LAD stenosis, the patients with proximal LAD lesions had a lower flow velocity at the peak of exercise (49 ± 32 vs. 61 ± 19 cm/s, P < 0.02), a lower ΔV (13 ± 19 vs. 26 ± 22 cm/s, P < 0.004), and a lower CFVR (1.4 ± 0.6 vs. 1.9 ± 0.7, P < 0.0001). In comparison with the control group, the patients with LAD stenosis had a lower flow velocity at the peak of exercise, a lower ΔV, and a lower CFVR. CONCLUSION Non-invasive CFVR measurement in the LAD could provide valuable additional information to a conventional echocardiography exercise test. In routine clinical practice, CFVR is sufficient for a diagnosis of severe stenosis.
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Affiliation(s)
| | | | - Emmanuel Egom
- Egom Clinical and Translational Research Services, Halifax, NS, Canada
| | - Gabriela Kovacova
- Fifth Department of Internal Medicine, University Hospital, Bratislava, Slovak Republic
| | - Peter Kruzliak
- Second Department of Internal Medicine, St. Anne’s University Hospital and Masaryk University, Brno, Czech Republic
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193
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Parato VM, Antoncecchi V, Sozzi F, Marazia S, Zito A, Maiello M, Palmiero P. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound 2016; 14:30. [PMID: 27519172 PMCID: PMC4982201 DOI: 10.1186/s12947-016-0072-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/19/2016] [Indexed: 01/19/2023] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is an inherited cardiovascular disorder of great genetic heterogeneity and has a prevalence of 0.1 – 0.2 % in the general population. Several hundred mutations in more than 27 genes, most of which encode sarcomeric structures, are associated with the HCM phenotype. Then, HCM is an extremely heterogeneous disease and several phenotypes have been described over the years. Originally only two phenotypes were considered, a more common, obstructive type (HOCM, 70 %) and a less common, non-obstructive type (HNCM, 30 %) (Maron BJ, et al. Am J Cardiol 48:418 –28, 1981). Wigle et al. (Circ 92:1680–92, 1995) considered three types of functional phenotypes: subaortic obstruction, midventricular obstruction and cavity obliteration. A leader american working group suggested that HCM should be defined genetically and not morphologically (Maron BJ, et al. Circ 113:1807–16, 2006). The European Society of Cardiology Working Group on Myocardial and Pericardial Diseases recommended otherwise a morphological classification (Elliott P, et al. Eur Heart J 29:270–6, 2008). Echocardiography is still the principal tool for the diagnosis, prognosis and clinical management of HCM. It is well known that the echocardiographic picture may have a clinical and prognostic impact. For this reason, in this article, we summarize the state of the art regarding the echocardiographic pattern of the HCM phenotypes and its impact on clinical course and prognosis.
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Affiliation(s)
- Vito Maurizio Parato
- Cardiology Unit and EchoLab of Emergency Department, Madonna del Soccorso Hospital, Politecnica delle Marche University, 3-7, Via Manara, San Benedetto del Tronto-Ascoli Piceno, 63074, Italy.
| | | | - Fabiola Sozzi
- Cardiology Unit, University Policlinico Hospital, Milan, Italy
| | | | - Annapaola Zito
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Maria Maiello
- ASL BR, Health Center, Districtual Cardiology, Brindisi, Italy
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Bianchini E, Bruno RM, Pitino A, Di Lascio N, Petersen C, Molinaro S, Faita F, Gemignani V, Ghiadoni L, Sicari R. Carotid-Ventricular Coupling During Exercise: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1747-1756. [PMID: 27353068 DOI: 10.7863/ultra.15.08059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/27/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate carotid elasticity and left ventricular elastance during a graded bicycle semisupine exercise test in patients with known or suspected coronary artery disease and compare them with a control group of healthy young volunteers. METHODS Thirty-six elderly patients and 18 young healthy volunteers were recruited. The right carotid diameter was estimated by an automatic system applied to B-mode sonographic sequences, central mean blood and pulse pressures by radial artery tonometry, and cardiac volumes by 2-dimensional transthoracic echocardiography; from these direct measurements, the carotid cross-sectional distensibility coefficient and left ventricular elastance index were obtained. Analyses were performed at rest, at peak stress, and during the recovery phase. RESULTS The elderly patients included 20 men (mean age ± SD, 61 ± 8 years); the volunteers included 9 men (mean age, 34 ± 3 years). The mean blood pressure (at rest: patients, 97 ± 7 mm Hg; controls, 93 ± 9 mm Hg; not significant) increased similarly in both groups during exercise and decreased during the recovery phase. The diameter was higher in patients than controls (7.5 ± 1.1 versus 6.2 ± 0.5 mm) and increased significantly with exercise only in the latter group (at peak: 6.5 ± 0.6 mm; P < .05). The distensibility coefficient and elastance index were lower in patients than controls during the test phases [at rest: 24.5 ± 10.2 versus 60.8 ± 21.3 × 10(-3)/kPa and 3.6 ± 1.4 versus 1.6 ± 0.8 mm Hg/(mL/m(2))] and mostly changed in the controls, showing a decreased distensibility coefficient (peak: 40.6 ± 15.1 × 10(-3)/kPa) and an increased elastance index [peak: 5.9 ± 2.8 mm Hg/(mL/m(2))]. CONCLUSIONS In older patients with multiple cardiovascular risk factors or established coronary artery disease, an abnormal carotid-ventricular adaptation to exercise was observed when compared to young healthy individuals.
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Affiliation(s)
| | - Rosa Maria Bruno
- Institute of Clinical Physiology, National Research Council, Pisa, Italy. Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Annalisa Pitino
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nicole Di Lascio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Christina Petersen
- Fondazione G. Monasterio, National Research Council-Regione Toscana, Massa and Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Vincenzo Gemignani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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195
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Ran H, Zhang PY, Zhang YX, Zhang JX, Wu WF, Dong J, Ma XW. Assessment of Left Ventricular Myocardial Viability by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Myocardial Infarction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1631-1638. [PMID: 27302895 DOI: 10.7863/ultra.15.09032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/30/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine whether 3-dimensional (3D) speckle-tracking echocardiography could provide a new way to assess myocardial viability in patients with myocardial infarction (MI). METHODS Forty-five patients with MI underwent routine echocardiography, 2-dimensional (2D) speckle-tracking echocardiography, and 3D speckle-tracking echocardiography. Radionuclide myocardial perfusion/metabolic imaging was used as a reference standard to define viable and nonviable myocardia. RESULTS Among 720 myocardial segments in 45 patients, 368 showed abnormal motion on routine echocardiography; 204 of 368 were categorized as viable on single-photon emission computed tomography/positron emission tomography (SPECT/PET), whereas 164 were defined as nonviable; 300 normal segments on SPECT/PET among 352 segments without abnormal motion on routine echocardiography were categorized as a control group. The radial, longitudinal, 3D, and area strain on 3D speckle-tracking echocardiography had significant differences between control and nonviable groups (P < .001), whereas none of the parameters had significant differences between control and viable groups. There were no significant differences in circumferential, radial, and longitudinal peak systolic strain from 2D speckle-tracking echocardiography between viable and nonviable groups. Although there was no significant difference in circumferential strain between the groups, radial and longitudinal strain from 3D speckle-tracking echocardiography decreased significantly in the nonviable group. Moreover, 3D and area strain values were lower in the nonviable segments than the viable segments. By receiver operating characteristic analysis, radial strain from 3D speckle-tracking echocardiography with a cutoff of 11.1% had sensitivity of 95.1% and specificity of 53.4% for viable segments; longitudinal strain with a cutoff of 14.3% had sensitivity of 65.2% and specificity of 65.7%; 3D strain with a cutoff of 17.4% had sensitivity of 70.6% and specificity of 77.2%; and area strain with a cutoff of 23.2% had sensitivity of 91.5% and specificity of 82.8%. CONCLUSIONS Three-dimensional speckle-tracking echocardiography might have potential for detection of myocardial viability in patients with cardiac dysfunction due to MI.
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Affiliation(s)
- Hong Ran
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - Ping-Yang Zhang
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - You-Xiang Zhang
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - Jian-Xin Zhang
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - Wen-Fang Wu
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - Jing Dong
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
| | - Xiao-Wu Ma
- Department of Echocardiography, Nanjing First Hospital, affiliated with Nanjing Medical University, Nanjing, China
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Sinning JM, Jansen F, Hammerstingl C, Meier A, Losch J, Rohwer K, Schmitz T, Paul K, Sedaghat A, Schueler R, Vasa-Nicotera M, Müller C, Nickenig G, Werner N. Circulating Microparticles Decrease After Cardiac Stress in Patients With Significant Coronary Artery Stenosis. Clin Cardiol 2016; 39:570-577. [PMID: 27410166 DOI: 10.1002/clc.22566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/28/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac stress leads to a dynamic increase of circulating microparticles (MPs) in healthy individuals that is diminished in individuals with vascular disease. The impact of coronary ischemia on circulating MP level is unknown. This study investigates the kinetics of circulating MPs during cardiac stress in patients with coronary artery stenosis. HYPOTHESIS Patients with significant coronary stenosis show altered circulating MP levels after cardiac stress. METHODS Eighty patients with stable coronary artery disease underwent dobutamine stress echocardiography (DSE) on the day before coronary angiography. Before, immediately after, at 4 hours, and at 24 hours after DSE, blood was drawn to determine CD144+ endothelial microparticles (EMPs), CD14+ CD16+ monocyte-derived microparticles (MMPs), and CD31+ CD42b+ platelet microparticles. A significant stenosis was defined as stenosis diameter ≥70% in a major native epicardial coronary artery with a diameter of ≥2.5 mm. RESULTS Significant coronary artery stenoses were found in 41 patients. In these patients, CD144+ -EMP and CD14+ CD16+ -MMP concentrations decreased immediately after DSE. Stimulation of target endothelial cells with sera from patients with significant coronary artery stenoses significantly augmented endothelial capacity to take up EMPs, but not MMPs, in vitro. Serum-induced enhancement of endothelial phosphatidylserine receptor expression was found as a potential mechanism of increased endothelial EMP uptake and subsequently reduced circulating EMP levels after cardiac stress. CONCLUSIONS Cardiac ischemia leads to reduced circulating MP levels under cardiac stress. Changes of endothelial MP uptake capacities could be one possible mechanism.
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Affiliation(s)
- Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
| | - Felix Jansen
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | | | - Arne Meier
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan Losch
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Katharina Rohwer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Theresa Schmitz
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Kathrin Paul
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Robert Schueler
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mariuca Vasa-Nicotera
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Cornelius Müller
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
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Michelsen MM, Pena A, Mygind ND, Frestad D, Gustafsson I, Hansen HS, Kastrup J, Bech J, Høst N, Prescott E. Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler: The iPOWER Study: Factors Influencing Feasibility and Quality. J Am Soc Echocardiogr 2016; 29:709-16. [DOI: 10.1016/j.echo.2016.02.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 01/07/2023]
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Prognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry. Int J Cardiol 2016; 219:331-8. [PMID: 27348413 DOI: 10.1016/j.ijcard.2016.06.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/19/2016] [Accepted: 06/12/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stress echo (SE) may have a role in the outcome in patients with hypertrophic cardiomyopathy (HCM). OBJECTIVES The aim was to assess the prognostic value of SE in a retrospective multicenter study in HCM. METHODS We enrolled 706 HCM patients. The employed stress was exercise (n=608) and/or vasodilator (n=146, dipyridamole in 98 and adenosine in 48). We defined SE positivity according to clinical/hemodynamic criteria including: symptoms (all stress modalities), exercise-induced hypotension (failure to increase or fall >20mmHg, exercise) and exercise-induced left ventricular outflow tract obstruction (left ventricular outflow tract obstruction >50mmHg); and ischemic criteria, such as new wall motion abnormalities (new wall motion abnormality) and/or reduction of coronary flow reserve velocity (CFVR≤2.0) on left anterior descending coronary artery with vasodilator stress assessed in 116 patients. All patients completed the clinical follow-up. RESULTS Positive SE showed more frequently CFVR reduction, exercise-induced hypotension, left ventricular outflow tract obstruction, and symptoms (38, 23, 20 and 15% respectively), but new wall motion abnormality only in 6%. During a median follow-up of 49months 180 events were observed, including 40 deaths. Clinical/hemodynamic criteria did not predict outcome (X2 0.599, p=0.598), whereas ischemia-related SE criteria (X2: 111.120, p<0.0001) was significantly related to outcome. Similarly, mortality was predicted with SE ischemic-criteria (X2 16.645, p<0.0001). CONCLUSIONS SE has an important prognostic significance in HCM patients, with ischemia-related end-points showing greater predictive accuracy than hemodynamic endpoints. New wall motion abnormalities and impairment of CFVR should be specifically included in SE protocols for HCM.
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Babu AS, Arena R, Myers J, Padmakumar R, Maiya AG, Cahalin LP, Waxman AB, Lavie CJ. Exercise intolerance in pulmonary hypertension: mechanism, evaluation and clinical implications. Expert Rev Respir Med 2016; 10:979-90. [PMID: 27192047 DOI: 10.1080/17476348.2016.1191353] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Exercise intolerance in pulmonary hypertension (PH) is a major factor affecting activities of daily living and quality of life. Evaluation strategies (i.e., non-invasive and invasive tests) are integral to providing a comprehensive assessment of clinical and functional status. Despite a growing body of literature on the clinical consequences of PH, there are limited studies discussing the contribution of various physiological systems to exercise intolerance in this patient population. AREAS COVERED This review, through a search of various databases, describes the physiological basis for exercise intolerance across the various PH etiologies, highlights the various exercise evaluation methods and discusses the rationale for exercise training amongst those diagnosed with PH. Expert commentary: With the growing importance of evaluating exercise capacity in PH (class 1, Level C recommendation), understanding why exercise performance is altered in PH is crucial. Thus, the further study is required for better quality evidence in this area.
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Affiliation(s)
- Abraham Samuel Babu
- a Department of Physiotherapy, School of Allied Health Sciences , Manipal University , Manipal , Karnataka , India
| | - Ross Arena
- b Department of Physical Therapy and Department of Kinesiology and Nutrition , University of Illinois at Chicago , Chicago , USA
| | - Jonathan Myers
- c Veterans Affairs Health Center , Stanford University , Palo Alto , CA , USA
| | | | - Arun G Maiya
- a Department of Physiotherapy, School of Allied Health Sciences , Manipal University , Manipal , Karnataka , India
| | - Lawrence P Cahalin
- e Department of Physical Therapy , Millers School of Medicine , Miami , FL , USA
| | - Aaron B Waxman
- f Pulmonary Vascular Disease Program, Dyspnea and Performance Evaluation Center, Pulmonary Critical Care Medicine, Cardiovascular Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Carl J Lavie
- g Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School , The University of Queensland School of Medicine , New Orleans , LA , USA
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Shah BN, Senior R. Stress echocardiography in patients with morbid obesity. Echo Res Pract 2016; 3:R13-8. [PMID: 27249552 PMCID: PMC4989093 DOI: 10.1530/erp-16-0010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/07/2016] [Indexed: 11/08/2022] Open
Abstract
The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE.
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Affiliation(s)
- Benoy N Shah
- Department of Cardiology, Wessex Cardiac Centre, University Hospital Southampton, Southampton, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, UK National Heart & Lung Institute, Imperial College London, London, UK
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